In every family there is a child whose designation is that of number one son. Girl or boy. Oldest, middle or youngest. Someone comes to earn this title over years of demonstrating grace under pressure, reliability, common sense and a sense of duty to those tied to him or her by the accident we know as “family”.

I have written a bit before about my father. He has a progressively terminal lung disease that has been stable for the last year but he is nearly eighty-one and his health is failing despite the relatively hopeful prognosis on the lung front from his pulmonary doctor in the spring.

He is a lucky man. He has nearly died at least three times in the last two and a half years. There is really no medical rationale for the fact that he has survived this long. And in my opinion, making the “old” half of old age is an accomplishment for which not all of us will be allowed bragging rights.

I knew it was coming and it still stabbed me a good one.

Dad’s been sleeping most of the day and night these last few weeks. He won’t eat. He barely drinks. He falls often and if he skins himself when he does, he bleeds profusely. And he really can’t breathe. His oxygen levels have fallen below 80% without his oxygen tank. When I told my best friend, who is a home health care nurse, this she was shocked that his doctor didn’t admit him to the hospital right on the spot when his low levels were discovered at his appointment today.

But why would have she? There is nothing more that can be done. My mother even admitted tearily today that she is overwhelmed and fearful about what is to come.

She got no magic words of wisdom from me either. As I have told Rob on more than one occasion, I don’t have anything profound to say on the subject of death and dying. So I empathized and reminded her that just because we know what is coming and need to hold it together to take care of business, it doesn’t make it suck any less.

I also broached the subject of hospice care. It’s time.

That’s what number one sons do. They say the things that need to be said – out loud – and to the people who need to hear them. They make the calls, as I did to my friend so I would have the names and numbers of people and places to contact, and then begin the slow task of getting everyone on board the train. Trains, after all, leave the station whether everyone is aboard or not. Number one sons try to make sure everyone is accounted for and seated before that happens.

I called my younger brother first. He lives in California. My dad gave him a one way airline ticket when he was eighteen and I have seen him only sporadically in the last twenty-three years. In fact years have literally passed when I didn’t even hear from him, but after my first husband died he made a point of calling me periodically to see how I was and he was one of the first members of my family to support my decision to move to Canada and marry Rob. It’s very ironic. I am not close to either my brother or my father but both did what they could to support me during Will’s illness and after his death.

My brother has always been tormented. As a small child he couldn’t be given a toy with any measure of assurance that he wouldn’t destroy it. Not accidentally either. He killed all of our gerbils. He threatened to kill each of us during his heavy substance abusing days. He turned down the social worker’s offer to dig deeply into his adoption records, which was probably a mistake in hindsight, as there was substance abuse although we don’t know the extent.

When I called, he answered. Not a good sign in the middle of the day. It usually means he has lost another job or is on the verge. He is on the tippy-toe leading edge and far more scary than I have known him to be and I have seen him in states that made the hairs on my arms and the back of my neck stand up and quiver.

Skipping the gory details, I will say that my brother is mentally ill and desperately needs help which he may or may not be getting this week. It was hard to follow his rambling. I have long-suspected that his difficulties and substance abuse stem from an undiagnosed mental disorder. Possibly bi-polar. My dad had an older sister who was bi-polar and I taught several kids with the illness and they all reminded me of my brother. It was a taxing conversation and it scared me enough to call his ex and suggest she call his doctor or 911. They have children together and are still entangled in a complicated relationship, so I imagine she will at least investigate my concerns.

I did tell him about dad. It didn’t really register. My sisters have informed me that he is my problem to deal with, but I don’t expect that we will see him again.

My next call was to my mother to let her know that I had contacted my brother. I let her know the status quo there. She was not surprised but is too caught up in care giving and what is happening in her immediate world to do more for him.

We discussed hospice again and she was a bit more open when I explained that hospice is fully covered between Medicare and her insurance and that it was not about imminent death but quality of life and care for patients and their families.

Then it was on to the hard sell, my younger sister.

Occasionally I feel bad that she is the DNOS* now that I am living in Canada. She never expected to be the one to look after our parents in their old and infirm years. She was the princess, dad’s favorite. She was pretty and popular. Sure to marry. Whereas I was the spinster and everyone knows that the unmarried sib gets stuck with the sickly parent watch.

But I unexpectedly married at 35 and had a child then went on to escape the first round of dad’s illness with my own dying then dead husband.

Widowhood turned out to almost be an out clause for her as both she and my mother pressured me to move back to the hometown during my first year of widowhood. I was considering it, but then came Rob.

My conversation with sister was strained once the word “hospice” was uttered. Like most people she associates it with rapid death. I managed to somewhat mollify her but didn’t quite make the sale. Next week when we are in Iowa (the water situation has improved there), I will have a lot of assessing and talking to do. Even as far away as I am, I am still the number one son.

*designated number one son – it’s a pinch hitting sort of thing